Abstract 2247: A Very Early Neurological Improvement After Intravenous Thrombolysis For Acute Cerebral Ischemia Does Not Necessarily Predict A Favorable Outcome.

Abstract

Background: in patients treated by intravenous (i.v.) thrombolytic therapy after cerebral ischemia, a very early neurological improvement (VENI) (National Institutes of Health Stroke Scale score [NIHSSS] 0, or early improvement >5 points), predicts a favorable outcome. VENI patients are therefore usually excluded from trials testing complementary strategies. However, a few of them have bad outcomes. Objective: to determine why VENI patients may have bad outcomes Methods: we analyzed the reasons for bad outcomes (modified Rankin scale [mRS] score 2 to 6 at month-3) in consecutive VENI patients. Results: of 365 consecutive patients with a pre-stroke mRS 0-1 (185 men; median age 69 years; median NIHSSS 12; median onset-to-needle time 147 min), 71 (19.5%) had VENI. They were more likely to have had recent transient ischemic attacks (OR: 3.64; 95% CI: 1.08-12.27), higher baseline NIHSSS (median 14 vs. 11; p=0.003), and shorter onset-to-needle times (median 135 min vs. 151; p=0.01), and less likely to develop pneumonia (OR: 0.27; 95% CI: 0.09-0.76) or malignant infarction (p=0.045). In the 21 VENI patients (29.6%) with a mRS 2 to 6 at month-3 , bad outcomes were due to the residual deficit in 14, secondary worsening of ischemia in 4, intracranial hemorrhage in 2, and death from cancer in 1. Conclusion: one-third of VENI patients have bad outcomes, due to the residual neurological deficit in most of them. This finding suggests that VENI patients who still have a significant neurological deficit one hour after thrombolysis should not be excluded from trials testing complementary strategies.